Can Reform Changes in Wellness Programs Impact Growing Obesity Problems Long Term?
By Holly Wright, R.D.
It is now estimated that about two-thirds of American adults are overweight or obese and the prevalence has increased 61% in the last decade. There has been a 36% increase in healthcare spending associated with obesity in the last few years.
There is no question whether drastic measures like gastric bypass and gastric bands contribute significantly to the increasing cost of obesity and healthcare costs overall. For example, Washoe County School District in Nevada estimated in one year alone it spent $300,000 on direct costs associated with obesity, and $1 million on gastric bypass surgeries.
In randomly reviewing a center for bypass surgery’s website online, they state “although gastric bypass patients lose about 50% of their weight during the first year, less than 20% keep it off after 10 years. The problem resides in the fact that unless one modified their eating habits, they are able to work around the surgical solution by eating softer foods or just continue to eat in excxess despite feeling full. Ultimately, success depends on diet modification and exercise and not the gastric bypass procedure alone.”
As a seasoned dietitian who has seen extreme obesity countermeasures come and go, including jaw wiring and the round of gastric bypass surgeries in the 1980s, it always comes back to inclusion of the key basics of diet and exercise. Diet programs may produce weight loss over the short term, but keeping this weight off, with or without a gastric band, can be a problem and often requires making exercise and a lower calorie diet a permanent part of a person’s lifestyle. Success rates of long-term weight loss maintenance are low and range from 2-20%.
However, with health care reform changes and increasing support of corporate wellness programs, perhaps we are finally taking advantage of another key factor that has been known for a long time to potentially lead to successful long term weight reduction? The fact that weight reduction has been shown to be more successful in a “more structured setting” with 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later. An average maintained weight loss of more than 3 kg (6.6 lb) or 3% of total body mass could be sustained for five years.
The success of programs like Weight Watchers as a known “structured setting” support group based on the similar goal of weight reduction is well known, and other diet groups have utilized this group culture concept with success. Perhaps with changes in healthcare reform for corporate wellness programs and increasing awareness, we can finally take advantage of corporate wellness programs that also create the “structured setting” or support in the workplace necessary to have an impact on obesity? Perhaps if we combine a supportive corporate culture with a sense of personal responsibility to diet and exercise, we can even move toward the much needed cultural shift necessary to dramatically decrease obesity?
There are now some great success stories out there with corporate wellness programs. In fact, the Washoe County School District mentioned above successfully instituted a weight loss program after their costly year with obesity, and paid employees $10 per lost pound up to 25. Program participants missed three or fewer work days a year, producing a $15.60 cost savings per program dollar spent.
A 2004 University of Michigan study of 23,000 GM employees showed that non-exercising workers claimed at least $100 more per year in healthcare costs than exercisers. Obese sedentary employees who began exercising twice a week lowered their costs by $500 a year.
The Wellness Council of America estimates the cost per employee to be between $100 and $150 per year for an effective wellness program that produces a return on investment of $300 to $450. Below are the key healthcare reform changes that may potentially help us create even more corporate wellness programs and improve the effectiveness of the existing programs to reduce obesity.
Employers can increase incentives to promote corporate wellness programs.
Starting in 2014, employers can offer bigger incentives for employees’ participation in health promotion programs with wellness incentives increasing from 20 to 30 percent. The Kaiser Family Foundation’s 2009 Employer Health Benefits nationwide survey found that the average 2009 total premium for employer-sponsored health insurance was $13,375 for family coverage. This means that the additional 10 percent incentive increase calculates out to a credit of $1,337 per employee per year. The same survey found the single person coverage average for an employer in 2009 was $4,824, which would translate into a $483 additional tax credit in 2014.
The number of corporate wellness program participants goes up.
As outlined in various sections of the healthcare reform bill, millions of dollars will be spent on the development of a national health promotion plan which will include public education about the importance of community wellness, workplace wellness and health promotion programs.
Better information on benchmarking best practices in wellness programs
Federal workforce wellness programs will be evaluated and reported on to Congress by the Department of Health and Human Services. Best practices will be presented as well as program failures to help set guidelines for the future. The bill’s section 4402 states that the evaluations will include, but not be limited to, “absenteeism of employees, the productivity of employees, the rate of workplace injury, and the medical costs incurred by employees, and health conditions, including workplace fitness, healthy food and beverages, and incentives in the Federal Employee Health Benefits Program.”
Long term measurement of effectiveness of employer health policies and programs
By 2013, surveys will be conducted nationwide on worksite health policies and programs and assessed by the Department of Health and Human Services. These surveys will then be conducted on a regular basis periodically to measure the effectiveness of the programs and the impact on chronic disease prevention and health promotion long term. The report to Congress will include recommendations on how to implement effective employer-based health programs and policies. The surveys are outlined in Sec. 399 MM-1 of the bill.
Small businesses’ tax credits to rise to 35 percent, then to 50 percent
From now through 2013, eligible small businesses (fewer than 25 employees with average annual wages of $50,000 or less), can receive a tax credit of up to 35 percent of their contribution if they pay for at least half of their employees’ premiums. In 2014 and 2015, if small businesses buy insurance on the insurance exchanges (which begin in 2014), the tax credit rises to 50 percent. The savings might mean some additional funds available for wellness programs, which will reduce premiums over the long term. These changes are detailed in Sec. 1421.
$200 million in grant money to implement wellness programs
Companies with less than 100 employees who work more than 25 hours a week who do not currently have a wellness program can apply for a grant during a 5-year program beginning in 2011. This is referenced in Sec. 1048, and the program must include: 1) screenings and assessments; 2) methodology to encourage employee participation; 3) “initiatives to change unhealthy behaviors and lifestyle choices”, which would include counseling, seminars and online programs; 4) workplace policies to encourage healthier lifestyles in order for companies to qualify for part of the $200 million in grant money.
Quick unhealthy snack fixes from vending machines must have caloric content listed on clearly marked labels
This change takes effect next year and hopefully will make some employees think twice about eating that tempting candy bar or treat. Sec. 4205 holds this information.
So as a registered dietitian with the American Dietetic Association who has worked with obese patients or clients for over 10 years, I feel encouraged that we are moving a step closer to offering more support in the workplace as we try to create a culture of wellness that supports weight loss through diet and exercise.
However, what programs will we put in place to be successful long term as we move away from paying monetary incentives to encourage weight reduction? Somewhere down the road long term, ideally we may need to go back to basics of diet and exercise with the reward being better health. We need to create a shared vision with our workforce and a corporate culture that believes that better health is enough.